Valentina Bressan

The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review.

BACKGROUND Combined-modality treatment of head and neck cancer is becoming more common, driven by the idea that organ(s) preservation should maintain patient appearance and the function of organ(s) involved. Even if treatments have improved, they can still be associated with acute and late adverse effects. The aim of this systematic review was to retrieve current data on how swallowing disorders, dysgeusia, oral mucositis, and xerostomia affect nutritional status, oral intake and weight loss in head and neck cancer (HNC) patients. METHODS A systematic literature search covered four relevant electronic databases from January 2005 to May 2015. Retrieved papers were categorised and evaluated considering their methodological quality. Two independent reviewers reviewed manuscripts and abstracted data using a standardised form. Quality assessment of the included studies was performed using the Edwards Method Score. RESULTS Of the 1459 abstracts reviewed, a total of 25 studies were included. The most studied symptom was dysphagia, even if symptoms were interconnected and affected one other. In most of the selected studies the level of evidence was between 2 and 3, and their quality level was from medium to low. CONCLUSIONS There are limited data about dysgeusia, oral mucositis and xerostomia outcomes available for HNC patients. There is a lack of well-designed clinical trials and multicenter-prospective cohort studies, therefore further research is needed to ascertain which aspects of these symptoms should be measured.

Moral distress in undergraduate nursing students A systematic review

Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education. Research design: The research design was a systematic literature review. Method: The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check. Ethical consideration: Since this was a systematic review, no ethical approval was required. Findings: From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses. Conclusion: Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students.

The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis

PurposeIn the literature, there is limited research about the changed meaning of food, the eating and the eating experience during treatment in patients with head and neck cancer. This systematic review includes findings from a qualitative research synthesis to gain a deeper understanding of the influence and experiences of dysphagia, dysgeusia, oral mucositis and xerostomia in head and neck cancer patients (HNC) and suggests recommendations for care practice.MethodA systematic review and meta-synthesis techniques were adopted to identify, appraise and synthesize the relevant literature regarding the experience of nutritional symptoms of HNC patients conducted according to the PRISMA guidelines. Several electronic databases such as PubMed, CINAHL, Scopus, PsycINFO and the Cochrane Library databases were searched.ResultsA systematic search yielded 121 papers, of which 12 met the inclusion criteria. A thematic account of shared nutritional symptom experiences reported across studies is highlighted and presented. Eight major themes covering three key supportive care domains were identified: impact of symptoms (symptoms during treatment, symptoms working together, affecting daily living activities and physical changes, symptoms and food changes), changing social networks and support (social life restrictions, support of peers), nutritional concerns and strategies (coping strategies, professional support).ConclusionsDysphagia, dysgeusia, oral mucositis and xerostomia negatively affected the patients’ quality of life throughout the period of treatment. The patients’ nutritional symptom experiences do not occur in isolation. Therefore, acknowledging the patients’ eating difficulties and challenges can guarantee appropriate management and support to best manage symptoms in a timely manner.

Perceived barriers to the professional development of modern nursing in Italy – A discussion paper

The aim of this paper is to discuss the development of modern nursing in Italy. Specifically, the paper aims to draw attention to the fact that while nursing in Italy has mirrored developments in Europe, in many respects the advancement of the profession is much less accelerated. The paper considers the reasons for this and the contributing factors and explores possible solutions.

Barriers to research awareness among nurses in Italy

The achievement and spread of evidence-based practice, of which research use is a key factor, is challenging and requires more than desire and enthusiasm (Rickbeil & Simones 2012). Using research in nursing practice requires research awareness. Research awareness has been determined as having not only having a good understanding about the principles of research; but the confidence and authority to use research (McSherry et al. 2006). While little is known empirically about Italian nurses’ confidence and authority with regard to research, anecdotally both are low (Bressan et al. 2016). In keeping with international trends (Timmins et al. 2012, Gerrish and Clayton 2004) nurses’ research awareness in Italy is anecdotally affected by a lack of resources, confidence, knowledge, and the lack of a strategic leadership (Sasso et al. 2013). In some Italian health care settings, there are also reports of a culture that is not attuned to the use of research use, and in some cases there is limited managerial support. Additionally it has been acknowledged internationally that competing demands in an under-resourced health care environment place nurses in a position whereby they prioritise care and thus miss out some aspects that could be deemed of lesser priority (Kalisch et al. 2009). A recent Italian study found that up to 41% of care that nurses were expected to perform was missed (Sasso et al., 2016a,b).Within this context it has been found that nurses [understandably] prioritise the most urgent nursing tasks (usually tangible clinical tasks) at the expense of less tangible aspects of nursing (such as communication, developing relationships and patient education) (Sasso et al., 2016a,b, Aiken et al. 2012, Sermeus et al. 2011). However of greater concern is that the percentage of this ‘missed care’ is higher in Italy compared with other countries most likely due to a much lower staff/patient ratio than many European counterparts (Sasso et al., 2016a,b). While research awareness is not specifically measured within these studies it is very likely that is given a low priority due to the aforementioned constraints. There are also few national or local financial incentives for research and clear leadership within the discipline is lacking (Bagnasco et al. 2014). While there has been an impetus at national level towards setting up a national nursing research strategy this has never translated into a reality (Sansoni 2001). At the same time key nursing figures in Italian universities are actively working towards building research capacity (Bagnasco et al. 2014). As a result while published research in nursing was notably weak in the past, and mostly led by non-nurses, this situation is improving with an increasing number of robust nurse-led research and publications, with direct relevance to clinical nursing practice (Marucci et al. 2013). A further compounding factor in the use of research is limited access to libraries and Information Technology (IT) resources and the language barrier (Bressan et al. 2016, Sasso et al. 2013). As English is considered to the language of the health sciences this creates difficulty for Italian nurses who struggle with English comprehension (da Silva et al. 2009). At the same time publications in Italian do not always highlight the practical implications of the findings and/or the recommendations often have a limited evidence base (Fazzini 2012). Dissemination of Italian nursing research results in English peer reviewed is therefore essential to create a robust body of literature (Marucci et al., 2015, Sansoni et al. 2006). This would facilitate the exchange of knowledge and information with international colleagues, encourage debate and facilitate cultural exchange and dissemination (Marucci et al. 2013). One additional barrier to research in nursing is that some local regional research ethics committees are notoriously bureaucratic and frequently refuse or return applications made by nurse researchers on the grounds that they are not considered to be pertinent for the ethics committee. The need for qualitative research is not fully understood, for example, nor is it perceived as warranting ethical approval (Gallagher et al. 2014). While this does not necessarily hinder research on patients or nurses, Italian nurses as a result have difficulty getting their research published in prominent peer reviewed international journals without the necessary ethical approval. This issue affects not only professional confidence and international development but also the circulation and development of national research. For research-based practice to become a reality it needs to proceed through four distinct phases: research; communication of the research; reading and understanding the research; and research utilization (Jacobson 2000), and we have highlighted above that there are

Student perspectives on: Does nursing have a future?

Our answer is ‘‘Yes, Nursing does have a future’’ . . . if our society perceives its usefulness, it will ask for its professional services, and if nurses will know how to value their own competences so that they may respond effectively to the new and changing needs of the population. The population’s future healthcare demand is increasing due to emerging global phenomena such as aging and chronic illnesses, causing serious issues of financial sustainability in many countries. In the future, along with the hospital services, there will be the need to have a well-structured network of community services to ensure healthcare continuum to all. In addition, there could be a change in the composition of the different professional profiles within the health workforce, with less physicians and the need to rethink the roles and the scopes of practice of other health professionals. Many studies have highlighted the important role nurses play, especially highly educated nurses, in improving patient outcomes. More nurse practitioners will have to provide besides care, taking directly care of patients (or better persons) and their informal carers/caregivers. There will be no future for nursing if its deep relationship is lost with the sick person (the ‘‘infirm,’’ which is the root of the Italian word for nurse ‘‘infermiere’’) and does not rediscover the great value of caring for the human body, according to the concept of ‘‘embodiment.’’ Nursing actions must continue to bear a high ethical value paying attention to the dignity and autonomy of the person, to the vision of the human being seen both individually and globally, and to the defense of human life in any circumstance and condition. Higher education needs to be reinforced, especially in the clinical field, so that it may stimulate innovation and research, as well as prepare professionals capable of providing high-quality care. It must be able to prove what is the added value and the real advantages of a nurse’s independent professional practice within the framework of healthcare systems that are radically changing. This scenario also offers new opportunities for the development of nursing, which would, however, need to be supported by its leadership to generate and value new competences. The latter would need to be addressed in order to respond effectively to the new and changing healthcare needs of the population and at the same time be pragmatic and flexible enough to adapt to new contexts and situations. The ethical conduct expected from nurses redeems them from the old role of mere executors of prescriptions made by others and encourages nurses to develop and assert their dignity as professionals, equipped with their own relational, educational, and technical competences.

Ethical dimensions of paediatric nursing: A rapid evidence assessment:

Background: Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, ‘What are the most common ethical dimensions and competences related to paediatric nursing?’ Research design: A rapid evidence assessment. Method: According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. Findings: Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. Conclusion: Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses’ perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.

Adverse events witnessed by nursing students during clinical learning experiences: Findings from a longitudinal study

No evidence from any longitudinal study design has been reported to date with regard to patient safety (PS) incidents witnessed by nursing students during their training. Therefore, with the aim of closing this gap in available knowledge, a longitudinal study was performed from 2012 to 2015 by involving all nursing students (n = 145) enrolled in two Italian nursing programs. At the end of each academic year, students were invited to report in writing all PS incidents witnessed during their clinical learning experience; the number of days each student spent in their clinical setting was also collected from administrative records. Ninety students were included and 94 incidents were reported: 17 (18.1%) by first year students, 27 (28.7%) by second year students, and 50 (53.2%) by third year students. One third of students did not report any PS incident at the end of each academic year, while only a few reported more than one. The incidence density was 3.8/1000 days of clinical training without statistical differences across academic years. Supporting nursing students by encouraging them to share, discuss, and reflect on their clinical learning experience might increase their confidence in reporting safety incidents.

Instruments evaluating the self-directed learning abilities among nursing students and nurses: a systematic review of psychometric properties

BackgroundModern healthcare institutions are continuously changing, and Self-Directed Learning (SDL) abilities are considered a prerequisite for both nursing students and nurses in order to be proactive about these demanding challenges. To date, no systematic reviews of existing instruments aimed at detecting and critically evaluating SDL abilities have been published. Therefore, the aims of this review are: 1) identify the instruments for assessment of SDL abilities among nursing students and nurses; 2) critically evaluate the methodological studies quality; and 3) compare the psychometric properties of the available instruments.MethodsA psychometric-systematic-review was performed. CDSR, CINAHL, ERIC, MEDLINE, PROSPERO, SCOPUS databases were searched without restrictions in time and setting. All primary studies involving nursing students or nurses, written in English and aimed at validating SDL assessment tools, were included. Studies retrieved were evaluated according to the COnsensus-based-Standards for the selection of health Measurement-INstruments (COSMIN) panel. Study inclusion, data extraction and quality assessment were performed by researchers independently.ResultsEleven studies were included and four tools based on Knowles’s theory have emerged: 1) the Self-Directed Learning Readiness Scale; 2) the Self-Directed Learning Readiness Scale for Nursing Education; 3) the Self-Rating Scale of Self-Directed Learning, and 4) the Self-Directed Learning Instrument. A few psychometric properties have been considered in each study, from two to four out of the ten required. The quality of the methodologies used was in general, from fair to poor with the exception of one instrument (the Self-Directed-Learning-Instrument). The psychometric proprieties that emerged across the tools were good in general: the Cronbach α was from 0.73 to 0.91; structural validities have also reported good indexes both in the explorative and in the confirmative factor analyses.ConclusionsOn the basis of the findings, the Self-Directed-Learning-Instrument can be recommended for the assessment of SDL abilities among nursing students and nurses, given the excellent methodology quality adopted in estimating the psychometric properties. However, rigorous study designs aimed at estimating psychometric properties of tools in wide samples of nursing students and nurses across different stages of professional life, from undergraduate education to professional maturity, in different cultural, educational, and work settings, are strongly recommended.